多腔主动脉夹层血流动力学仿真模拟研究

Hemodynamic numerical simulation study of patients with multichanneled aortic dissection

中文关键词: 多腔主动脉夹层    血流动力学    仿真模拟    计算流体力学    胸主动脉腔内修复术

英文关键词: multichanneled aortic dissection  hemodynamics  computational fluid dynamics  numerical simulation  thoracic endovascular aortic repair

中文摘要:

      目的 通过计算流体力学(CFD)构建个体化模型，明确多腔主动脉夹层(MCAD)术前核心血流动力学特征，并结合术后随访数据分析血流动力学参数改变与临床结局的关系。方法 回顾性纳入复旦大学附属中山医院2例MCAD患者，基于CFD方法及个体化主动脉模型，实现患者术前腔内血流动力学参数压力分布及流场特征的三维可视化模拟。同时，结合患者临床结局纵向对比术后血流动力学参数变化，明确血流动力学特征与疾病转归的关联。结果 血流动力学分析显示，MCAD患者术前假腔对真腔形成压差优势，且存在局部高速血流区。支架植入术后，真假腔压力差逆转，血流速度分布更加均匀，但残余破口处持续血流灌注延缓了假腔血栓化进程。结论 MCAD患者主动脉存在压力梯度失衡与局部高速血流刺激两大核心血流动力学特征，主动脉各流腔解剖形态与血流动力学参数的耦合作用可能是MCAD患者预后不良的共同驱动因素。

英文摘要:

      Objective This study aimed to construct patient-specific models using computational fluid dynamics(CFD)to identify the core preoperative hemodynamic characteristics of multichanneled aortic dissection(MCAD),and to analyze the corresponding relationship between changes in hemodynamic parameters and clinical outcomes by integrating postoperative follow-up data.Methods Two MCAD patients were retrospectively enrolled.Based on CFD and patient-specific aortic models,three-dimensional visualized simulation of preoperative intraluminal hemodynamic parameters(including pressure distribution)and flow field characteristics was achieved.Meanwhile,combined with the patients′ clinical outcomes,longitudinal comparison of postoperative changes in hemodynamic parameters was conducted to clarify the logical association between hemodynamic characteristics and disease prognosis.Results Preoperatively,the false lumen dominated the true lumen in pressure gradient with localized high-velocity flow regions.After endovascular repair,the true lumen regained pressure superiority with more uniform velocity distribution,while persistent flow perfusion through residual entry tears delayed false lumen thrombosis.Conclusion MCAD is characterized by two core hemodynamic features:pressure gradient imbalance and local high-velocity flow stimulation.The coupling effect between the anatomical morphology of each aortic lumen and hemodynamic parameters in MCAD patients may be a common driving factor for the poor prognosis of MCAD.